CHRONIC KIDNEY DISEASE

The Philippine Situation

 National Nutrition and Health Survey

 Philippine Renal Disease Registry

 Mortality statistics
 Survival data from a cohort study
 NATIONAL NUTRITION SURVEY

 Resulted from the mandate of the Food and

Research Institute (FNRI) of the Dept. of
Science and Technology (DOST)

 Objective: To assess the Philippine food

situation and nutritional status of the
population

 Conducted every 5 years since 1978

 NNHeS 2003-2004
Objectives

 To assess the prevalence of lifestyle and

nutrition-related risk factors and diseases
among Filipinos 2 years and above

 To aid in the development of health policies

an programs for the prevention and control
of lifestyle and nutrition-related diseases
 NNHeS 2003-2004 Renal Report
Chronic Kidney Disease Stages

Stage GFR

1 >=90 Normal or increased GFR

2 60-89 Mildly decreased GFR
3 30-59 Moderately decreased GFR
4 15-29 Severely decreased GFR
5 <15 Kidney failure

Based on guidelines of the Dialysis Outcomes Quality Initiative – US

U
 NNHeS 2003-2004 Renal Report
Renal function

• Abbreviated MDRD formula

– Predicted GFR = 186.3 * (serum creatinine)− 1.154
* age− 0.203 * (0.742 for women) * (1.21 if African
American)
• Cockcroft & Gault formula
– Ccr (mL/min) = (140 − age)/sCr * weight/72 *
1.73/BSA, where age is in years, sCr is in
mg/dL, weight is in kilograms, and BSA is body
surface area using the formula:
– BSA = 0.20247 × [height (m)]0.725 × [weight
(kg)]0.425
 NNHeS 2003-2004 Renal Report
Prevalence of CKD in adults
using predicted GFR from MDRD equation

Stages of GFR

1 >=90 72.8%
2 60-89 24.6%
3 30-59 2.2%
4 15-29 0.2%
5 <15 0.2%

The prevalence of CKD Stage 3-5 is 2.6%

 NNHeS 2003-2004 Renal Report
Prevalence of CKD in adults

The population of Filipinos aged 20

years and above in 2005 was
46,627,172

A prevalence of 2.6% means that

1,212,306 adult Filipinos
have CKD.
 NNHeS 2003-2004 Renal Report
Macroalbuminuria

 at least +1 proteinuria using the

Multiple Reagent Strip for Urinalysis®

(Bayer Corporation)

The prevalence of
macroalbuminuria was

4.2%
NNHeS 2003-2004 Renal Report
Microalbuminuria

The prevalence of
microalbuminuria was

18.5%

This is equivalent to

8,626,027
Adult Filipinos
 NNHeS 2003-2004 Renal Report
Prevalence of CKD Stage 3-5
according to AGE

S tag e 3 S tag e 4 S tag e 5

25
20.7%
20

15

10 7.5%
5.0% 2.9%
5
0.3% 1.0%
0
20-29 30-39 40-49 50-59 60-69 70+
 Mean level of GFR by age group:
Philippine vs. US data

Age Group NNHeS 2003 NHANES III

in Years Philippines U.S.A.

20-29 119 116

30-39 109 107
40-49 103 99
50-59 100 93
60-69 86 85
70+ 77 75
PHILIPPINE RENAL DISEASE REGISTRY

 Originated by the PSN in 1996 and later

became a joint project with REDCOP

 Collects data on ESRD patients who start

hemodialysis, peritoneal dialysis and
undergo kidney transplantation
 NEW PATIENTS ON DIALYSIS
2001-2005

Number of Patients

7 0 00
5997
6 0 00 5597
5070
5 0 00
4363 44 0 9

4 0 00

3 0 00

2 0 00
2001 2002 2003 2004 2005
 NEW PATIENTS ON DIALYSIS: 2001-2005
ACCORDING TO DIALYSIS MODALITY
Number of Patients

7000
5997
6000 5597 TOTAL
5070
5000 4363 4409
4000
HD
3000

2000

1000
PD
0
2001 2002 2003 2004 2005
 ACCEPTANCE RATE TO RRT PROGRAMS
(PMP)
Data from International Federation of Renal Registries
website and the Philippine Renal Disease Registry

PHIL 2003 71 PMP

PHIL 2004 55 PMP
PHIL 2005 63 PMP
INDONESIA 68 PMP
CHINA

MALAYSIA

AUSTRALIA

KOREA

INDIA

SPAIN

CANADA

MEXICO

US

0 50 100 150 200 250 300

Patients per million population

 ACCEPTANCE RATE TO RRT PROGRAMS
(PMP)
Data from International Federation of Renal Registries
website and the Philippine Renal Disease Registry

PHIL 2003 71 PMP

PHIL 2004 55 PMP
PHIL 2005 63 PMP
INDONESIA 68 PMP
CHINA

MALAYSIA

AUSTRALIA

KOREA

INDIA

SPAIN

CANADA

MEXICO

US

0 50 100 150 200 250 300

Patients per million population

 PRIMARY RENAL DISEASE OF ALL
NEW DIALYSIS PATIENTS
N = 5,997
HD PD

OTHERS

APKD

GOUT

OBSTR

UNK

CPN

HPN
20%
GN 26%
DM
38%

0 500 1000 1500 2000 2500

 DISTRIBUTION OF
TOP 3 CAUSES OF ESRD

2002 2003 2004 2005

2500

2000

1500

1000
t nei t a P f o r e b mu N

500

0
DM GN HPN
 NNHeS 2003-2004 Renal Report
Prevalence of CKD Stage 3-5
according to AGE

MEAN AGE – 2004 PRDR DATA

S tag e 3 S tag e 4 S tag e 5
ALL NEW DIALYSIS PTS 52
YEARS
25 20.7%
ESRD - DM NEPHRO 58
YEARS
20
ESRD – HTN NEPHRO 57
15 YEARS
ESRD – CGN 38
10 YEARS 7.5%
5.0% 2.9%
5 0.3% 1.0%

0
20-29 30-39 40-49 50-59 60-69 70+
END STAGE RENAL IS A BAD
DISEASE TO HAVE

Limited survival
Expensive
 Retrospective cohort study of 327 patients from NKTI and
SLMC diagnosed to have ESRD 2000-2001
OVERALL SURVIVAL

Kaplan-Meier survival estimate

1.00

0.75

0.50

0.25

0.00
365 730 1000
analysis time

12 month estimated survival rate - 53% (95%CI: 47-

58)
24 month estimated survival rate - 36% (95%CI: 30-
42
 Results
PATIENT GROUP

Service – n=198 (60%) Private – n=129 (40%)

1.00

0.75
Private

0.50

0.25
Service

0.00
365 730 1000
days

Log rank test: chi2 = 29.62, p<.001

 National Statistics Office

Kidney disease is now no. 10 cause

of mortality in the Philippines
 Renal
Disease
Registry
NNHes ESRD
GROWING PROBLEM
Population survival
OF CHRONIC KIDNEY
Survey data
DISEASE

National
mortality
data
Treatment is too expensive

Prevention is the key

Kung hindi tayo ang kikilos
Sino ang kikilos?

Kung hindi ngayon, kailan pa?

The Philippine College of Physicians wishes to
acknowledge the following for their invaluable
contribution in the preparation of this module

Philippine Society of
Nephrology